1. 2009;12;189-194Continuous Cervical Epidural Analgesia for Rehabilitation after Shoulder Surgery: A Retrospective Evaluation
   Observational Study
   Samer N. Narouze, MD, Harsh Govil, MD, Maged Guirguis, MD, and Nagy A. Mekhail, MD, PhD.

BACKGROUND: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation.

OBJECTIVE: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder.

METHODS: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively. These patients had cervical tunneled epidural catheter (TEC) placement for continuous infusion of a mixture of low-dose narcotic and local anesthetics at the time of surgery and were discharged home with the catheter in place. They were then involved in an active physical therapy program to increase the range of motion of the affected shoulder joint.

The patients (N = 21) were followed for a median of 4.7 weeks. They were assessed for range of motion, function, visual analog pain scores (VAS), and opiate use before the surgery and after tunneled epidural catheter removal.

RESULTS: Statistically significant changes from the time of placement to the time of removal of the tunneled epidural catheter (TEC) were observed for VAS pain score and range of motion of the shoulder in forward flexion, external rotation, and internal rotation. The mean rate of change among the patients for pain score, forward flexion, external rotation, and internal rotation was also computed. The mean change per week in each of these 4 measurements significantly differed from zero. 33 percent of the patients returned to work within one week.

CONCLUSION: Our data show that the continuous infusion of epidural opioids and local anesthetics through a tunneled cervical epidural catheter during the rehabilitation phase after shoulder surgery for adhesive capsulitis may be a safe and effective tool for post-operative pain control and to facilitate rehabilitation.